The Democrats won a majority partially because of the economic collapse caused by Republican economic policies. American voters, especially those in the tea party, have such a short memory that many now want to vote the Democrats out of office because of the state of economy. They are totally oblivious to the fact that the economy, with all its problems, is in far better shape than we would have predicted in January 2008. It certainly makes no sense to vote for the party which is responsible for this mess.

Among the absurd accounts of public opinion on this subject was seen in coverage of a poll a week or two ago. People were quoted as saying they would vote Republican because of being unemployed. They were angry about no longer receiving their unemployment benefits. Of course if they were paying attention they would realize that the Democrats have been trying very hard to pass an extension of the benefits, but that a Republican minority in the Senate has been successful so far in blocking them with the filibuster. While at most times I’d be wary about one party having so much power, the more rational response to this situation would be to work to give Democrats a large enough majority to pass their agenda.

It now looks like there is hope for passage of extension of unemployment benefits, but Republicans still might benefit politically from their strategy of making things as bad as possible to hurt the Democrats politically. The Republicans remain far better than the Democrats on the spin war, especially with the rightward bias of much of the broadcast media, but at least Democrats making some attempts. I was happy to see Barack Obama make an issue of the Republican obstruction of jobless benefits this week (video above). The Hill reports:

Obama slams GOP for stalling jobless benefits

President Obama slammed Senate Republicans Saturday for blocking the extension of unemployment benefits.

In his weekly radio address, Obama said keeping those benefits in place would put money in people’s pockets, leading to more consumer spending that could boost local economies. Instead, the president said the minority party is stopping that from happening by filibustering the legislation.

“Too often, the Republican leadership in the United States Senate chooses to filibuster our recovery and obstruct our progress. And that has very real consequences,” Obama said. “Over the past several weeks, more than two million of them have seen their unemployment insurance expire. For many, it was the only way to make ends meet while searching for work — the only way to cover rent, utilities, even food.”

The president said in his address that the Senate has failed three times to extend unemployment benefits with Republicans blocking an up-or-down vote on the bill. Obama said the extension of unemployment benefits should be not controversial and has been treated as a necessary emergency expenditure during economic crises by lawmakers in both parties in the past.

Of course Republicans who don’t want to spend the money on unemployment benefits have no problem with the effect on the deficit of extending the Bush tax cuts for the wealthy.

While misguided, at least it can be said that Pelosi meant well, motivated by a desire to promote economic recovery, which certainly could not be said of the Republicans. After the Senate passed a Medicare fix as a separate measure, she was under the mistaken belief that she had some leverage over Senate Republicans by blocking a vote on the Senate measure.

I am surprised at how badly Pelosi misread the Republicans. Republicans were willing to vote for the Medicare “doc fix” but certainly would not be heartbroken if it failed and they could blame Democrats for destroying Medicare. Even if they were actually in support of the measure, their opposition to spending money on jobs or the unemployed certainly trumped any such feelings.

It is very clear that the Republicans in the Senate want this economy to fail. They see that things are beginning to turn around. You know the numbers. When this president took office, we were losing 750,000 jobs a month. … Now we are gaining jobs. … Unfortunately, and cynically [on their part], in cynical political terms, it doesn’t serve them in terms of their elections if things are beginning to turn around.

I believe when you look at this bill, which is all paid for — we raised revenues to pay for it — the one piece that is technically not paid for [is the federal unemployment benefit extensions and] that is done in a way that we have always done it, … [those are] always categorized as an emergency. And, frankly, if 15 million people without jobs is not an emergency, I don’t know what is.

Ezra Klein provided this political interpretation earlier in the day when he anticipated the loss on the jobs measures:

And still, it looks like Democrats might lose the vote today. And when I say “lose the vote,” I don’t mean that a majority of the Senate will vote against it. I mean that 58 senators, rather than 60, will support the legislation. All Republicans, and possibly Ben Nelson, appear to remain opposed. And why not? The less that Democrats appear to be doing on jobs — and the fewer jobs that Democrats actually create — the better Republicans will do in November. Substantial compromises on the bill haven’t brought any new votes, and that’s in part because Republicans see no political upside in passing the legislation.

While it made no sense for Pelosi to believe that the threat of not passing the Medicare fix would get Republicans to vote for unemployment benefits, at least she did quickly back down and get the Medicare fixed later the same day.

Getting this passed quickly was important for a number of reasons. After postponing the processing of payments since the beginning of June, Medicare began processing payments with the 21 percent cut. It will now be necessary to reissue these checks with the updated amount. Earlier in the week I saw estimates that this would cost $15 million, and this would increase with every batch of Medicare payments which must be reprocessed. The delay also increases expenses for physicians and undermines confidence in Medicare. This might lead more doctors, who now see Medicare patients at a considerable discount compared to commercial payers, to decide against accepting Medicare patients.

Now that it is established that both parties agree that this needs to be fixed, hopefully we can also achieve a permanent fix to the Medicare payment formula before the end of the year. Attempts last year failed because the Republicans had wanted to include this cost in the cost of health care reform and use it as another bogus argument against reform. Now that health care reform has been passed hopefully the Republicans will not see further political gain in blocking a permanent fix.

The failure of Congress to act on the Medicare “doc fix” has led to protests from medical organizations and the American Association of Retired People who have pointed out the harm this will do to the Medicare program and people dependent upon Medicare for their health care. The American Academy of Family Practitioners has called on Congress to stop harming patients and do their job. The American College of Physicians has blasted Congress for causing “Irreparable damage to Medicare” as seniors and military families face loss of access to health care. AARP sent the following letter to every member of Congress urging action on Medicare, warning that their inaction “threatens access to physician services for millions of Medicare beneficiaries.”

On behalf of millions of AARP members, I urge you to immediately pass legislation that ensures seniors have access to their physicians, and provides much needed fiscal relief to the states and to unemployed individuals.

Regrettably, given Congress’s failure to reach timely agreement on a Medicare physician pay package, the Centers for Medicare and Medicaid Services has now been forced to implement a draconian 21.3 percent reduction in their reimbursements. This cut threatens access to physician services for millions of Medicare beneficiaries – especially those living in rural and other underserved areas.

While Congress continues to debate temporary patchwork solutions, people on Medicare are growing increasingly anxious about whether they will be able to find a doctor when they need one. Seniors, who have paid into Medicare their entire working lives, deserve the peace of mind of knowing they will be able to find a doctor who will treat them.

AARP urges Congress to act immediately to stabilize doctor reimbursement rates for as long as possible until a permanent solution can be found. For nearly a decade, Medicare patients and the doctors who treat them have been held hostage by short-term patches to an unworkable Sustainable Growth Rate (SGR) formula. In the months to come, we look forward to working with Members of Congress from both sides of the aisle to repeal the SGR formula and replace it with a permanent physician payment system for Medicare that rewards value and ends the uncertainty for patients and providers alike.

In addition, enhanced Medicaid funding to states to assist them with the added costs of providing health coverage to low income individuals and for home and community based services must be extended.

Finally, we urge the extension of unemployment benefits for those unable to find jobs during this economic downturn.

AARP members are counting on you to address these critical issues immediately to protect their health and economic security.

Medical blogs have been protesting the failure of Congress to resolve this problem. For example, Dr. Rob warns that Congress is playing “a great big game of chicken.”

The house is playing chicken with the senate.

The Democrats are playing chicken with the Republicans.

They aren’t in the cars themselves, we are. Doctors and patients are careening toward destruction in the name of political gamesmanship.

Surely they will flinch. Surely someone will understand the consequences of the crash. But you know what? Sometimes each side expects the others will be the ones who flinch. Sometimes nobody flinches. Sometimes the cars crash and people are killed.

There are two potential ways to resolve this deadlock. The quickest would be for Nancy Pelosi to go along with Senate Majority Leader Harry Reid, House Majority Leader Steny Hoyer, and Rep. Robert Andrews (D-N.J.), the Chair of the Education and Labor health panel, and allow the House to vote on the temporary fix passed in the Senate last week.

Nancy Pelosi has been insisting on a different course by attaching the Medicare “doc fix” to other unrelated legislation. The Senate is attempting to pass legislation which includes some of Pelosi’s goals, but it is questionable if the Senate could pass such legislation without watering it down to the point where Pelosi would not find it acceptable.

For Nancy Pelosi to be the one who, at present, is blocking passage of this legislation might be political suicide for the Democrats, risking turning over control of Congress to the Republicans in November. The Democrats are already on shaky ground with seniors. As Ezra Klein pointed out earlier today, health care reform has become more popular since passage–except with seniors. The Democrats cannot afford to further alienate the senior vote, which tends to turn out more heavily in off year elections than the younger voters who are more likely to stick with the Democrats.

The Senate finally passed a fix for Medicare payments late on Friday but doctors remain disappointed that they still could not pass a permanent fix for the flawed payment formula due to objection from Republicans. At least this fix extends for six months and, besides preventing an automatic 21 percent pay cut, provides for a 2.2 percent increase. Congressional Democrats have been trying to achieve a permanent fix since last year but the Republicans have successfully blocked every attempt.

Medicare payments were held through yesterday in hopes that the fix would be passed by then. Payments began to be issued today based upon the reduced fee schedule with the increased amount to be paid retroactively once the bill becomes law. I can recall one time in past years in which this happened. Besides forcing Medicare intermediaries to process the extra payments, this creates extra book keeping headaches for physician offices which must post payments twice and change billings for patient co-payments.

The bill still must pass the House and be signed by President Obama. It is not clear how soon this will be completed and whether Medicare will continue to send payments at the lower amounts or again hold payments pending final passage.

The cuts in reimbursement stem from a payment formula based on the sustainable growth rate, or SGR, a program Congress set up in 1997 that tied the payments doctors received for treating these patients to the nation’s gross domestic product. But even though the cuts were scheduled to take effect at the turn of the millennium, a series of quick fixes have pushed the schedule back.

Congress has instituted such delays nine times over the past eight years, most recently last April.

When it was implemented, the formula was well intentioned, said Stuart Guterman, assistant vice president at The Commonwealth Fund, an independent research organization. But since then it has misfired, because it doesn’t focus on the reasons behind the rise in spending and specific services that are overpriced.

It’s that formula that needs to be fixed to make the program sustainable, medical professionals concur, rather than simply imposing temporary fixes to override the payment cuts without addressing the root causes of the growth in expenditures.

“We’re left with a choice between a temporary fix that just ‘kicks the can down the road’ without fixing the underlying problem and a 21 percent across-the-board cut in physician fees that would cut primary care as well as specialty care, distort incentives, hurt beneficiaries, and severely damage the credibility of the Medicare program,” Guterman told ABC News. “The recurring cuts in physician fees produced by the SGR formula must be eliminated in order to achieve effective payment and delivery system reforms.”

But many lawmakers are concerned about the costs associated with such a fix. The Congressional Budget Office estimates that over the next two years, such a fix would tack an additional $22 billion to the federal deficit.

While on paper this does add additional money to the deficit, in reality Congress has been passing bills to override the payment cuts for several years and a permanent fix would represent this reality as opposed to adding spending which was not already expected.

The news was not all good today. While it is good news that we won’t have to worry about this for another six months, I fear even greater gridlock next year assuming the Republicans pick up more seats in November. In addition, the Democrats were unable to pass extension of unemployment benefits over Republican opposition.

The overall Republican strategy seems to screw up as many things as possible and then try to blame the Democrats. Conservatives have been falsely claiming that ObamaCare is forcing doctors to stop accepting Medicare when it has actually been the Republicans who are to blame. Under the current flawed payment formula, unless Congress votes to override the formula doctors will receive a 21% cut. As action from Congress is required to prevent this, Republicans can (and on several occasions in the past several months have) block passage of bills to prevent the automatic cut despite being in the minority.

In a last-minute shock to physicians, the Senate voted today against postponing a scheduled 21% reduction in Medicare reimbursement to physicians and other health providers.

A compromise proposed by Sen. Max Baucus (D-MT) was defeated largely along party lines, with no Republican support. The compromise was put forward after the Senate had rejected a $140 billion finance package yesterday that would have delayed the cut in Medicare payments to physicians until 2012, along with measures to extend unemployment benefits and provide $24 billion to states to cope with their Medicaid programs.

The lower-spending compromise bill, dropping the total cost to $118 billion and the overall deficit impact from $79 billion to $55 billion, would have delayed the planned Medicare cuts and provided a 2.2% raise for physicians through November 30, rather than for the 19 months mandated by the earlier bill.

It still was not enough, however, to win over the 60 senators needed to end debate on the issue under Senate rules. Fifty-six senators voted in favor, with 40 opposed. Opponents argued that the overall measure was not offset by spending cuts and added too much to the deficit.

More than a decade ago, Congress set up a formula that governs how doctors get paid by the Medicare program. The intent was to slow the growth of Medicare costs, but the result was a formula that has proposed cutting payments for America’s doctors year after year after year. These are cuts that would not only jeopardize our physicians’ pay, but our seniors’ health care.

Since 2003, Congress has acted to prevent these pay cuts from going into effect. These votes were largely bipartisan, and they succeeded when Democrats ran Congress and when Republicans ran Congress – which was most of the time.

This year, a majority of Congress is willing to prevent a pay cut of 21% — a pay cut that would undoubtedly force some doctors to stop seeing Medicare patients altogether. But this time, some Senate Republicans may even block a vote on this issue. After years of voting to defer these cuts, the other party is now willing to walk away from the needs of our doctors and our seniors.

Now, I realize that simply kicking these cuts down the road another year is not a long-term solution to this problem. For years, I have said that a system where doctors are left to wonder if….

… they’ll get fairly reimbursed makes absolutely no sense. And I am committed to permanently reforming this Medicare formula in a way that balances fiscal responsibility with the responsibility we have to doctors and seniors. In addition, we’re already taking significant steps to slow the growth of Medicare costs through health insurance reform – not by targeting doctors and seniors, but by eliminating 50% of the waste, fraud, and abuse in the system by 2012. This not only strengthens Medicare, it saves taxpayer dollars.

I’m absolutely willing to take the difficult steps necessary to lower the cost of Medicare and put our budget on a more fiscally sustainable path. But I’m not willing to do that by punishing hard-working physicians or the millions of Americans who count on Medicare. That’s just wrong. And that’s why in the short-term, Congress must act to prevent this pay cut to doctors.

If they don’t act, doctors will see a 21% cut in their Medicare payments this week. This week, doctors will start receiving these lower reimbursements from the Medicare program. That could lead them to stop participating in the Medicare program. And that could lead seniors to lose their doctors.

We cannot allow this to happen. We have to fix this problem so that our doctors can get paid for the life-saving services they provide and keep their doors open. We have to fix this problem to keep the promise of Medicare for our seniors so that they get the health care they deserve. So I urge Republicans in the Senate to at least allow a majority of Senators and Congressmen to stop this pay cut. I urge them to stand with America’s seniors and America’s doctors. Thanks.

Republicans have suddenly become concerned about the deficit after running the government on credit while in power. Not only have they been blocking modest increases in payments, they have blocked efforts at simply keeping Medicare payments at current levels.

Barack Obama gave another excellent commencement speech following his recent speech at The University of Michigan, this time at Hampton University in Virginia. Of course to read the coverage from the right wing media and blogs one would get a totally different take on what he said–which ironically is one of the messages of his speech. For an example, compare the reporting at Pajamas Media (along with their off the wall description of liberalism) to the actual text of Obama’s speech (under the fold).

Similar distortions are present on multiple conservative blogs. Once again the danger to democracy from the distortion and manipulation of information by extremist forces can be seen by simply comparing what someone has said to how their words are twisted by the right wing noise machine.

The economy still has problems but the jobs numbers were better than predicted with 290,000 new jobs:

Despite growing unease in the financial markets, the American economy is gathering steam, adding an unexpectedly large number of jobs last month.

The Labor Department’s monthly snapshot of the job market, released on Friday, showed that employers added 290,000 jobs in April, the largest gain in four years, and that they did so across a broad swath of industries. The United States has now added jobs for four straight months.

The unemployment rate, however, crept up to 9.9 percent from 9.7 percent in March, mostly because of a significant increase in the number of people who had previously given up deciding to look for work again…

“I think at this point the U.S. economy has a very good chance of being able to continue its recovery despite the uncertainty in Europe,” said Bernard Baumohl, chief global economist at the Economic Outlook Group. “But the threat is real, and we have to be vigilant and very nimble.”

President Obama called April’s job report “particularly heartening.” He noted that “this week’s job numbers come as a relief to Americans who’ve found a job, but it offers, obviously, little comfort to those who are still out of work.”

All manner of businesses were hiring, including those in manufacturing, leisure and hospitality and health care. One of the strongest gains occurred in manufacturing, which added 44,000 jobs, the largest increase since 1998.

Steve Benen has updated his bikini graph showing the differences under Bush and Obama, adding the new numbers and updating the graph due to include revised numbers for earlier in the year.

The Senate has passed the temporary spending bill this evening to restore funding for several programs including unemployment benefits, COBRA benefits, and Medicare payment to doctors. The House already passed similar legislation to extend payments through April. A Senate amendment extending the payments until June 1 requires that the House vote again on the legislation, which is expected later tonight. The benefits, which have been on hold since April 1 due to Republican filibusters, will be restored retroactively.

Earlier today the Senate ended a Republican filibuster designed to block debate on temporary funding measure for programs including unemployment benefits, COBRA, and maintaining Medicare payments at current rates. The vote was 60-34 with four Republicans, Scott Brown, George Voinovich, Susan Collins, and Olympia Snowe voting with the Democrats. It is hoped that this clears the path to pass another extension of this spending, but it also remains possible that the Republicans can slow this down with further procedural moves.

Because of Republicans blocking unanimous consent of a temporary spending measure over 200,000 people will have their unemployment benefits cut off on Monday. They might be restored retroactively, but many of these people are probably do not have spare money to hold them over. The Hill reports:

The interruption in benefits will last two weeks at a minimum, according to Judy Conti of the National Employment Law Project (NELP), since lawmakers return from spring break on April 12.

As the two-week recess began, Congress was at an impasse over how to extend the emergency unemployment insurance program and other expiring provisions, including increased COBRA health insurance subsidies for the unemployed, the Medicare doctor payment rate and federal flood insurance.

Senate Republicans said the $9.3 billion, 30-day extension preferred by Democrats should be paid for, while Democrats said the bill’s cost didn’t need to be offset because the program was “emergency spending.”

Making matters worse, the Republicans are trying to play politics and blame the Democrats for the problem. They insist upon paying for this emergency spending now, but had no problems in the past with conducting the Iraq war or passing George Bush’s Medicare changes without funding them. They also have had no problems with the increases to the deficit caused by George Bush’s tax cuts which were initially provided to only the ultra-wealthy. Republicans have also blocked efforts to achieve a permanent fix to the flawed Medicare payment formula.

Harry Reid has scheduled a cloture vote for when Congress returns on April 12 but even if passed this delay can cause hardship for many who are now unemployed and dependent upon the benefits for day to day expenses.